Audit/Investigation Coordinator II

ADP, Inc.; Easton (MD); Sur place; USD 29 000 - 33 000; Plein temps

Résumé du poste

Qlarant is a not-for-profit organization dedicated to preventing fraud and improving health and human services programs. The Audit/Investigation Coordinator II supports field-level judgments on complaints and leads of potential fraud investigations related to Medicare/Medicaid.

Under close supervision, you will review data, maintain case records, screen leads, gather information from complainants, and prepare intake reports to guide investigations.

Qualifications

• Minimum High School Diploma or GED required.
• 2–4 years of experience; 5–7 years preferred.

Responsabilités

• Reviews complaint data including allegations, subjects, and facts to ensure case tracking accuracy.
• Maintains data records in case tracking systems for timely processing.
• Screens incoming fraud leads by extracting information from sites and drafting a comprehensive case file.
• Confers with complainants to obtain clarification and verify services; drafts contact reports.
• Operates systems to obtain claims, enrollment, and provider/beneficiary information.
• Prepares intake investigation reports with relevant facts, risks, and leads for investigation by Lead Investigator.
• Processes RFIs to contractors and incorporates findings into audit/investigation files.
• Recommends opportunities to improve fraud audit/investigation processes and procedures.

Formation

High School Diploma or GED

Description du poste

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Audit/Investigation Coordinator II

Full Time Hourly Coordinator II Easton, MD, US

2 days ago Requisition ID: 1192

Salary Range: $21.00 To $24.00 Hourly

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.

Best People, Best Solutions, Best ResultsJob Summary:

Performs in-depth evaluation and makes field level judgments related to complaints and investigative leads of potential fraud investigations (e.g. Medicare and/or Medicaid) that meet established criteria for referral to the appropriate agency(ies) for administrative action or law enforcement.

Essential Functions:

• Reviews complaint data including allegations, subjects of the complaint, and facts of the complaint to ensure case tracking system is correctly populated and updated per pre-established timeframes.
• Maintains data records in the case tracking systems to ensure timely processing of cases.
• Screens incoming fraud leads by extracting information from sites related to the subject(s), utilizing a variety of resources and systems to capture the scope of fraud, and evaluating relevant legislation to draft a case file that is comprehensive and accurate.
• Confers with complainants and beneficiaries, as needed, to obtain clarification regarding complaints and to verify services to assist in drafting contact reports.
• Operates systems to obtain claims, enrollment, and provider/beneficiary information.
• Prepares intake investigation report, collecting all relevant facts, risks, and leads to recommend investigations to Lead Investigator.
• Processes requests for information (RFIs), as needed, to various contractors, reviews information upon receipt, and incorporates findings into audit/investigation file to ensure thorough audit/investigation files are delivered.
• Recommends opportunities to improve fraud audit/investigation processes and procedures ensuring industry best practices are being followed.

Level of Supervision Received:
Under close supervision, works closely with manager to prioritize efforts.Education (can be substituted for experience):
Minimum High School Diploma or GED requiredWork Experience (can be substituted for education):
2 - 4 years of experience required; 5 - 7 years preferred

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.